Lasser Michael S, Liao Jason G, Burd Randall S
Department of Surgery, Division of Pediatric Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ 08903, USA.
Pediatrics. 2006 Nov;118(5):1828-35. doi: 10.1542/peds.2006-1185.
The purpose of this study was to analyze recent nationwide trends in the use of and outcomes after antireflux surgery for children.
We conducted a retrospective cohort study of children (age: <18 years) undergoing antireflux surgery by using data from 1996 to 2003 from the Nationwide Inpatient Sample. Census data were used to calculate the population-based rates of procedures stratified according to age and presence of neurologic impairment. Multivariate analyses were performed to determine factors associated with length of stay and in-hospital death.
During the study period, 48,665 antireflux procedures were performed for children in the US. Although procedure rates were generally higher in 2003 than in 1996, no trends in rates were observed among different age groups and census regions during the study period. The highest population-based procedure rates were observed among infants (49-101 procedures per 100,000 population). There was a significant decrease in the percentages of children undergoing antireflux procedures who were neurologically impaired between 1996 and 2003 (53% vs 40%). Neurologically impaired children had longer lengths of stay and higher mortality rates than did neurologically normal children.
Although procedure rates have not changed, the use of antireflux surgery has evolved during the laparoscopic era, with a decreasing percentage of neurologically impaired children undergoing this procedure. Antireflux procedures were performed predominantly for infants, most of whom were neurologically normal. Neurologically impaired children remain a group at high risk for death after antireflux procedures.
本研究旨在分析近期全国范围内儿童抗反流手术的使用情况及术后结果。
我们利用1996年至2003年全国住院患者样本数据，对接受抗反流手术的儿童（年龄<18岁）进行了一项回顾性队列研究。使用人口普查数据计算按年龄和神经功能障碍情况分层的基于人群的手术率。进行多变量分析以确定与住院时间和院内死亡相关的因素。
在研究期间，美国为儿童实施了48,665例抗反流手术。尽管2003年的手术率总体上高于1996年，但在研究期间不同年龄组和人口普查区域未观察到手术率的趋势。基于人群的最高手术率在婴儿中观察到（每10万人口中有49 - 101例手术）。1996年至2003年间，接受抗反流手术的神经功能障碍儿童的百分比显著下降（53%对40%）。与神经功能正常的儿童相比，神经功能障碍儿童的住院时间更长，死亡率更高。
尽管手术率没有变化，但在腹腔镜时代抗反流手术的应用有所演变，接受该手术的神经功能障碍儿童的百分比在下降。抗反流手术主要针对婴儿进行，其中大多数神经功能正常。神经功能障碍儿童仍然是抗反流手术后死亡的高危人群。
